Diagnostik und Therapie der vestibulären Rezeptorfunktion

Zusammenfassung

Für die Diagnostik der Rezeptorfunktion des peripher-vestibulären Systems stehen seitenspezifische Testverfahren zur Verfügung. Die Funktion der Bogengänge kann mit dem Kopfimpulstest (KIT) und mittels Video-KIT sowie anhand der thermischen Prüfung objektiviert werden. Zur seitenspezifischen, quantitativen Beurteilung der Funktion der Otolithenorgane setzen sich die vestibulär evozierten myogenen Potenziale (VEMP) durch. Die Einschätzung der Sakkulusfunktion erfolgt mit zervikalen (cVEMP), die Diagnostik des überwiegenden Utrikulusanteils mit okulären Ableitungen (oVEMP). Diese neuen diagnostischen Entwicklungen tragen wesentlich zur Differenzialdiagnostik peripher-vestibulären Störungen bei. So können mittels VEMP-Differenzierungen des Krankheitsbildes der Neuritis vestibularis erfolgen und die diagnostische Sicherheit beim Morbus Menière erhöht werden. VEMP sind pathognomonisch bei der Dehiszenz der oberen Bogengänge. Aus therapeutischer Sicht sind die langfristige, hochdosierte Betahistintherapie des Morbus Menière sowie die intratympanale Medikamentenapplikation bei Innenohrstörungen aktuell.

Summary

Up to date lateral-specific testing procedures are available in order to diagnose the receptor function of the peripheral vestibular system. The function of the semicircular canals can be objectified by a head impulse test (HIT) and lately by means of video-HIT and also on the basis of a caloric test. Currently the vestibular evoked myogenic potentials (VEMPs) become prevalent for the lateral-specific quantitative evaluation of the otolith organ function.The assessment of the sacculus function is carried out with cervical vestibular evoked myogenic potentials (cVEMP); the diagnostics of the utriculus and superior vestibular nerve is accomplished via ocular VEMP (oVEMP). Those new diagnostic developments play an essential role in differential diagnostics of peripheral vestibular disorders.Thus by means of VEMP differentiations of the vestibular neuritis symptoms can be conducted and the diagnostic certainty in case of Meniere’s disease can be increased. VEMPs are pathonomonic in the dehiscence of the superior semicircular canals. Currently prevailing from a therapeutic point of view are the long-term highly dosed betahistine treatment in case of Meniere’s disease and also the intratympanic drug therapy in the event of inner ear disorders.

Schlüsselwörter

Schwindel - Gleichgewichtsstörungen - VEMP - kalorische Prüfung - Kopfimpulstest

Keywords

Vertigo - dizziness - VEMP - caloric irrigation - head impulse test

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